BNF for Children 2011-2012

BNFC 2011–2012 4.8.1 Control of the epilepsies 223Child 6 months–18 years, body-weight under50 kg initially 10 mg/kg once daily, increasedgradually by max. 10 mg/kg twice daily every 2weeks; max. 30 mg/kg twice dailyChild 12–18 years, body-weight over 50 kginitially 250 mg twice daily, increased gradually by500 mg twice daily every 2 weeks; max. 1.5 g twicedaily. By intravenous infusionNote If switching between oral therapy and intravenoustherapy (for those temporarily unable to take oral medication),the intravenous dose should be the same as theestablished oral doseChild 4–18 years, body-weight under 50 kginitially 10 mg/kg once daily, increased graduallyby max. 10 mg/kg twice daily every 2 weeks; max.30 mg/kg twice dailyChild 12–18 years, body-weight over 50 kginitially 250 mg twice daily, increased gradually by500 mg twice daily every 2 weeks; max. 1.5 g twicedailyAdjunctive therapy of myoclonic seizures andtonic-clonic seizures. By mouth or by intravenous infusionNote If switching between oral therapy and intravenoustherapy (for those temporarily unable to take oral medication),the intravenous dose should be the same as theestablished oral doseChild 12–18 years, body-weight under 50 kginitially 10 mg/kg once daily, increased graduallyby max. 10 mg/kg twice daily every 2 weeks; max.30 mg/kg twice dailyChild 12–18 years, body-weight over 50 kginitially 250 mg twice daily, increased gradually by500 mg twice daily every 2 weeks; max. 1.5 g twicedailyAdministration for intravenous infusion, dilute requisitedose with at least 100 mL Glucose 5% or SodiumChloride 0.9%; give over 15 minutesFor administration of oral solution, requisite dosemay be diluted in a glass of waterKeppra c (UCB Pharma) ATablets, f/c, levetiracetam 250 mg (blue), net price60-tab pack = £29.70; 500 mg (yellow), 60-tab pack =£52.30; 750 mg (orange), 60-tab pack = £89.10; 1 g(white), 60-tab pack = £101.10. Label: 8Oral solution, sugar-free, levetiracetam 100 mg/mL,net price 150 mL (with 1-mL or 3-mL syringe) =£42.60, 300 mL (with 10-ml syringe) = £71.00. Label: 8Concentrate for intravenous infusion, levetiracetam100 mg/mL, net price 5-mL vial = £13.50Electrolytes Na + 0.83 mmol/vialNote For dilution before usePhenobarbital and primidonePhenobarbital is effective for tonic-clonic, focal seizuresand neonatal seizures but may cause behaviouraldisturbances and hyperkinesia. It may be tried for atypicalabsence, atonic, and tonic seizures. For therapeuticpurposes phenobarbital and phenobarbital sodiumshould be considered equivalent in effect. Reboundseizures may be a problem on withdrawal. Monitoringthe plasma concentration is less useful than with otherdrugs because tolerance occurs.Primidone is largely converted to phenobarbital andthis is probably responsible for its antiepileptic action. Itis used rarely in children. A low initial dose of primidoneis essential.PHENOBARBITAL(Phenobarbitone)Cautions see also notes above; debilitated; respiratorydepression (avoid if severe); avoid abrupt withdrawal(dependence with prolonged use); history of drug andalcohol abuse; consider vitamin D supplementation inpatients who are immobilised for long periods or whohave inadequate sun exposure or dietary intake ofcalcium; avoid in acute porphyria (see section 9.8.2);interactions: see p. 215 and Appendix 1 (barbiturates)Hepatic impairment may precipitate coma; avoid insevere impairmentRenal impairment use with cautionPregnancy see Pregnancy, p. 216Breast-feeding avoid if possible; drowsiness mayoccur; see also Breast-feeding, p. 217Side-effects hepatitis, cholestasis; hypotension; respiratorydepression; drowsiness, lethargy, depression,ataxia, behavioural disturbances, nystagmus, irritability,hallucinations, impaired memory and cognition,hyperactivity; osteomalacia (see Cautions);megaloblastic anaemia (may be treated with folicacid), agranulocytosis, thrombocytopenia; allergicskin reactions; very rarely Stevens-Johnson syndromeand toxic epidermal necrolysis; suicidal ideation;overdosage: see Emergency Treatment of Poisoning,p. 25Pharmacokinetics trough plasma concentration foroptimum response 15–40 mg/litre (60–180 micromol/litre)Indication and doseAll forms of epilepsy except typical absenceseizures. By mouth or by intravenous injectionNeonate initially 20 mg/kg by slow intravenousinjection then 2.5–5 mg/kg once daily either byslow intravenous injection or by mouth; dose andfrequency adjusted according to response. By mouthChild 1 month–12 years initially 1–1.5 mg/kgtwice daily, increased by 2 mg/kg daily as required;usual maintenance dose 2.5–4 mg/kg once ortwice dailyChild 12–18 years 60–180 mg once dailyStatus epilepticus section 4.8.2Note For therapeutic purposes phenobarbital and phenobarbitalsodium may be considered equivalent in effectAdministration for administration by mouth, tabletsmay be crushedFor intravenous injection, dilute to a concentration of20 mg/mL with Water for Injections; give over 20minutes (no faster than 1 mg/kg/minute)4 Central nervous system